The creation of a midlevel dental provider has been a controversial topic since it was proposed in the 2008 legislature. There were voices strongly opposed to the idea, while others advocated for a broad scope of practice and great flexibility to practice under general supervision. In the end, legislation authorizing this new dental professional in Minnesota was signed into law earlier this year. The good news is that a variety of stakeholder groups who were engaged in the discussion remain committed to the success of this new practitioner. Now dental professionals have a unique opportunity to work together to successfully implement this legislation in a way that positively impacts our oral health care delivery system.
The legislation was enacted with the goal of increasing access to care for underserved populations. Many factors contribute to our access dilemma, including affordability of care, location of care, and cultural competence of care. Adding roughly 20 dental therapists a year to the workforce will not solve all of Minnesota’s access problems, but it certainly can be a part of the solution. Now that we have a new player on the team, we have a new opportunity, an opportunity to develop new and appropriate models of care delivery that can improve access and potentially reduce cost while simultaneously maintaining quality.
But there is much work to be done. We must be strategic about where and how dental therapists are best utilized. There cannot be a “one size fits all” approach to using dental therapists to increase access to care. Opportunities need to be created to collaborate with key stakeholders. Minnesota has a small but committed oral health care safety net. This group must be engaged in creating and testing new models of care delivery that utilize dental therapists. And since the legislation requires dentists to supervise and collaborate with dental therapists, it is important that we engage additional private practitioners, especially in greater Minnesota.
Strategic planning around the use of dental therapists has the potential to reduce cost and maintain a high quality of care. From a quality standpoint, research both in the United States and abroad has demonstrated that auxiliaries and dental therapists, in the proper setting, can be trained to prepare and place direct restorations, in a shorter timeframe, at the same level of quality as dentists.1 This, in part, is a consequence of their being able to focus on a narrow range of services. Similarly, as dentists focus their time on other more advanced procedures, the level of quality performed on those services also has the potential to increase. From a cost standpoint, we don’t know where the compensation of dental therapists will fall in the marketplace. In other countries such as Canada, New Zealand, and the United Kingdom, dental therapists are compensated at a level comparable with dental hygienists. If that becomes the case in Minnesota, it would give practices a great opportunity to provide more care at a lower cost. This could potentially make the treatment of Medical Assistance patients financially viable.
The key to success in Minnesota will be integrating dental therapists into our current delivery system in a manner that will achieve our goals of improving access and reducing cost. We cannot just import a dental therapy program from another country, as dental therapists are used differently in different countries. Other countries have different oral health goals, and their delivery systems do not mirror ours. However, we as dental providers cannot sit back and let chance determine how dental therapists should be brought onto the dental team. Fortunately, the timing for pursuing this effort could not be better. Other efforts to improve our oral health delivery system have recently been initiated. On the public policy side, the Minnesota Department of Health has received funding to create a State Oral Health Plan, and it is organizing an Oral Health Coalition comprised of stakeholders who also have an interest in dental therapy. On the private side, the Minnesota Dental Association has formed a Dental Therapist Task Force to ensure that dental therapy as created in Minnesota is viewed as a national model for dentistry and that dental therapists become a viable member of the dental team.
I believe these and other efforts that are beginning truly give us not only an opportunity to work together for success but an obligation to work together to achieve our goals of improving access to care, maintaining quality of care, and reducing the cost of care. I believe this is an opportunity for change. Most importantly, I believe this is an opportunity to improve oral health in Minnesota and to make a difference in people’s lives. To get involved in shaping the direction of how dental therapists should be integrated into the dental team, please consider contacting the Minnesota Dental Association at (612) 767-8400 or firstname.lastname@example.org or the Minnesota Department of Health. Phone is (651) 201-3749; email is Merry.Jo.Thoele@state.mn.edu
1. Minnsota Department of Health. Research Literature Review on Mid-Level Oral Health Practitioners; 2008. Available at http://www.health.state.mn.us./healthreform/oralhealth/researchliterature.pdf
*Dr. Self is a Comprehensive Care Group Leader, Department of Primary Dental Care, University of Minnesota School of Dentistry, Minneapolis, Minnesota. Email is email@example.com